...In its light, human history, for the first time, becomes intelligible, and human behaviour understandable as never before. This radical transformation in human understanding - which has come to a peak in the mid 1990's - I shall call "the new evolutionary enlightenment" . I confidently predict that, because it is based on fully tested scientific knowledge, it will far outshine the enlightenment of the 18th century.
-Derek Freeman-

En inglés:1) Cancer exists since man exists and before. To keep an organism working without rebellion aboard seems to be an everyday miracle. The bizarre thing is just not to have cancer rather than to have it, isn't it?

Yes, that is the counter-intuitive paradox. The ‘common-sense’ or prevailing view, even amongst the well educated public, is that evolution works by refining design towards perfection. Cancer, it follows, must be some grotesque aberration or insult. It does take some reflection and insight to appreciate that our bodies have been cobbled together by trial and error; with the inevitable consequence that there are design flaws, trade-offs and compromises on board and inherent vulnerability to defective function, including cancer. And that chance plays a big part. Not just that but that the critical properties of cancer cells: mutability, migration, territorial invasion, selfish cloning and immortality are intrinsic properties of cells positively selected by evolution. The surprise is indeed that we don’t all have multiple cancers. Of course evolution has also imposed hefty restraints on expression of these dangerous properties, particularly in long-lived, complex organisms such as us, but these too are imperfect controls. How could it be otherwise?

2) The genes express themselves trough the environment, as Matt Ridley said in its "Nature via Nurture". In the case of cancer, as a complex illness, it is not easy to discriminate between genetic and environmental factors. There are viral cancers and there are cancers with a clear hereditary component. But cancer is an evolutionary legacy, as you point out. Basically, it is a genetic illness (or set of illnesses). Do we, the potential victims, know what to do to fight it in our everyday lifes, within the margin that our genes permit? Does it exist a wide margin, in general? Isn't there too much press and too much fashion about health that hinders a good perception of what is worth to do or not to do?

We do have a problem in society of comprehending the complexities of cancer causation and its underlying genetics. The press and media in the UK, and I suspect elsewhere, have a hugely variable appreciation and skill in this respect from the balanced and very well informed to the lethal combination of ignorance and taste for sensationalism. It’s not surprising that the public become confused by supposed causes, and sceptical of claimed cures. There is a world of difference (e.g. in screening, genetic counselling, management, etc) between cancers involving inherited and highly penetrant mutant genes, such as BRCA1 and 2 in breast cancer, and the more common ‘sporadic’ cancers due to acquired (i.e. somatic) mutations arising via environmental exposures. The former should be dealt with by screening (and early intervention) and (in my view) by embryo selection; the latter by both screening where appropriate (for skin cancer), prophylactic vaccination (with HPV vaccines for cervical cancer) and, for many cancers, by lifestyle changes. Smoking is the most obvious example, but avoidance of excess sun exposure (for light-skinned individuals) and a healthy diet/exercise regime are others. It’s not rocket science. I rather agree with what the epidemiologists Doll and Peto said over 25 years ago: 80% or more of cancers are probably avoidable. Public education is crucial in this endeavour.

3) In the last century, what can statistics say about the evolution of different kinds of cancer? About its geographical distribution, age, occupation etc? Where does cancer evolution go?

The highly variable incidence rates of cancers, their geographic distributions and changes of time are clearly a reflection of how societies and individuals behave and change over time. Relatively rapid lifestyle fluctuations occur and are set against a pedestrian or stable genetics. Cervical cancer has probably been with us for millennia (for obvious reasons), lung cancers are a product of the industrial revolution, melanoma is a product of colonial migration and package holidays. Colon cancer will, I believe, eventually be nailed to modern dietary habits. Most breast cancers, even though they have a hefty genetic component, will I believe be seen as a mismatch between our evolutionary past and our modern lifestyle (- sorry ladies). It will, I’m afraid, continue to be so. Astronauts are, it is plausibly suggested, at high risk of cancers from excess cosmic radiation! The patterns change, we may get smarter at avoidance, early detection and therapy but my guess is the problem will always be with us, particularly as the demographics reflect increasingly large cohorts of surviving, geriatric individuals. It all comes back to our inherent genetics and error-prone ‘design’ mismatched with exotic lifestyles that evolve rapidly without the fitness filter of natural selection.

4) Research about protein P53 is going through. Do we have any remarkable advances that make us conceive some hopes for the near future since you wrote the book "Cancer, the evolutionary legacy" up to now?

There are grounds for optimism from insights into the molecular pathology of cancer and the identification of specific molecular targets for therapy. The best recent example is with Imatinib as an inhibitor of BCR-ABL kinase in chronic myeloid leukaemia (CML). At the same time, that story has illuminated the limitations that still have to be recognised and overcome. Resistance to Imatinib occurs rather inevitably in more advanced cases and some artful drug combinations (as with antibiotic therapy) will be required. CML is also a rather unusual, single gene-driven cancer and it isn’t at all clear if such ‘magic bullet’ tactics will be effective in the more challenging – and common, clinical targets: metastatic epithelial cancers with multiple genetic abnormalities. The hope has to be that even these highly evolved and genetically unstable cancers are addicted to a few, or one, mutant oncogene – or that they can be suffocated by blocking angiogenesis.

The other significant recent advance is the recognition that most cancerous clones are initiated, driven and sustained by rare populations of stem cells. Being able to identify, enumerate and perhaps manipulate these critical cells – the bull’s eye in the therapeutic target, is a major step forward.

5) You have professionally confronted yourself with the illness and death of kids, one of the worst evils of humankind. In the rapid development of infancy it can be thought that there are more risks of developing cancer. However, this is not this way. Cancer is more related with aging. Evolution can give the key, as you remark, because Natural Selection would favour good health (and organization trough) up to the mature age, up to the age when descent has been assured by parental care. In what way do you think the relative organism immunity operates at early ages? What are the biochemical mechanisms that protect us? Why is cancer more aggressive when it attacks younger people?

Cancer is, fortunately, relatively rare in the young. From the evolutionary point of view, this is entirely what you might anticipate. Inherent design flaws that significantly increase the risk of death in reproductive or pre-reproductive individuals and at an appreciable rate would be expected to be heavily selected against in evolution and constrained by controls. The latter include foetal loss by spontaneous abortion where DNA damage is excessive and apoptosis or senescence in stem cells and progenitors when they incur damage. In contrast, post-reproductive faults, including cancer, would be largely neutral or invisible to selection. That it still does happen in infants and children is still not really surprising; the proliferative stress of development on progenitor cells are such that inherent design limitations occasionally leak out as cancers (albeit at only ~1% the adult rate); indeed, we know, at least in the haemopoietic system, that generation of pre-leukaemic clones with single mutations during foetal development is very common. The vast majority of these never graduate to malignancy, clinically speaking.

The malignant credentials of cancers in infants, children and adolescents are in fact very variable. The major subtype of paediatric cancer – acute lymphoblastic leukaemia (ALL), is intrinsically drug-sensitive, as is testicular cancer. Wilm’s kidney tumours are reasonably responsive to available drug combinations but some others, e.g. brain tumours, are considerably more intransigent. This variability appears to reflect the cells of origin and the particular mutant genes commonly involved.

6) What role do you think evolutionary medicine has? What advantages has this approach, in particular for cancer?

The editor of a well known clinical journal in the UK asked me a similar question: what use is all this evolutionary medicine – as applied to cancer, for the practising clinician TODAY? I didn’t even bother to reply. For me, the intellectual or philosophical argument and evidence base comes first and potential pay-offs, just maybe, later. It seems to me glaringly obvious that understanding the basis of our apparent vulnerability to cancer and other common, chronic diseases prevalent, particularly in affluent societies, is of huge significance. To imagine that these illnesses befall our sacrosanct and perfected bodies entirely because of some insidious external insult may be commonplace but it is bizarre and wrong. We can’t turn the evolutionary clock back, but a coherent grasp of the intrinsic vulnerability that evolution has bequeathed us (along with manifold benefits) should at the very least endorse public health measures aimed at prudent avoidance or reduction of risk. If you knew your car was designed by a blind watchmaker with imperfect or faulty steering, you might be less inclined to drive fast. We should start by ensuring our medical students understand the consequences of bodily design by trial and error.

7) For a person, the diagnostic of cancer is one of the worst news. This has a strong psychological impact, which indeed affects physical health, as shown in your latest research. At least, the diagnosis predisposes the organism negatively, lowering defenses, among others. It is also known that people has higher propensity to cancer after traumatic episodes. How do you see the relationship between feelings, emotions and illness? Do you see an evolutionary meaning in that?

The issue between emotional state and cancer is a tricky one and has been a topic of debate and controversy for centuries. The ancient Greeks, including Hippocrates, believed that constitutive melancholy was a predisposing factor. In the 19th century, European surgeons (the only serious cancer specialists then) were somewhat obsessed with the idea that stress or neuroticism caused or precipitated cancer, especially amongst women. To call their evidence anecdotal would be flattery. Throughout the 20th century, there were those convinced that stress was a causative factor. The argument was usually that stress suppresses the immune system and, as a consequence, cancer is let off the leash. This of course presumes that the immune system really does efficiently indulge in surveillance against cancer. The evidence unfortunately suggests otherwise; it is active against viruses (and other microbes) – some of which may cause some particular cancers. So no, I don’t think emotional state is a major or significant player in cancer causation. Moreoever, I find it objectionable and unethical to impose such an opinion on patients.

There is an entirely separate debate as to whether emotional state impacts on treatment outcome. This I simply do not know but I understand that the evidence is mixed or ambiguous.

There is, to me, no obvious evolutionary rationale in this pseudo link between emotion and cancer, any more than there is in the belief that cancer is God’s will or divine retribution for past sins. No rationale, other than in our remarkable proclivity to believe in (or desire) simple stories and explanations. And to pin the blame on someone or something. Alas, real life, and biology, is more complicated.

Sarah B. Hrdy. American anthropologist and primatologist who has made several major contributions to evolutionary psychology and sociobiology.

"Recommendation of Javier Moreno, Germanico: Senor Moreno interviewed me on line for his compilation the New Evolutionary Enlightenment.I found his questions both intelligent and penetrating. I enjoyed answering them and being caused to think in depth about serious and sometimes fundamental matters. He has considerable talent in an area in which interviewers are prone to be lamentably superficial".

John Postgate, Profesor Emérito de Microbiología.de la Universidad de Sussex.

“Javier is editor of "The new Evolutionary Enlightenment" (http://ilevolucionista.blogspot.com), which is a blog concerned with the science and philosophy of Mind. His many interviews with leading researchers in this field provide valuable insights into current thinking about Mind.”

“Javier interviewed me as Editor of La Nueva Ilustración Evolucionista in a most knowledgable yet empathic way. I was well pleased with the result and consider that his on line site speaks for itself with so many excellent, highly readable and pertinent interviews. I can thoroughly recommend him".

“Javier interviewed me for his website http://www.ilevolucionista.blogspot.com/ in 2009. He has built up an impressive collection of interviews there with almost every key thinker in evolutionary psychology. This in itself is testimony to his professionalism, dedication, and intellectual curiosity".

Dylan Evans, Lecturer in Behavioural Science, University College Cork.

“Javier Moreno, aka "Germanico," has performed an important service in making the work of scholars and writers in the field of evolutionary biology and allied fields accessible to the wider interantional public by designing and curating the website La Nueva Ilustración Evolucionista / The New Evolutionary Enlightenment. From my own experience as one of the participants and a reader of dozens of other entries, I can attest that the interviews are conducted in a penetrating fashion with the objective of extracting the most distinctive aspects of each writer's work, the translations (between English and Spanish as required) are done in a careful and lucid fashion, and the physical production is of a high aesthetic quality. In my opinion, Javier has made an original and useful contribution to world culture".

Stuart Newman, Professor, New York Medical College.

"This website is an extraordinary labour of love, with detailed and penetrating questions to many of the leading figures in evolutionary biology. It is a tribute to the quality of the questions, and their creative online presentation, that so many notable evolutionary biologists have answered, not merely quick answers, but detailed and comprehensive essays in many cases. This is an unusual and meaningful achievement".

"One of the most interesting interview sites for the sciences of human nature, available to Spanish- and English-speakers alike".

Steven Pinker. Catedrático de Psicología en Harvard.

“Javier's website, The new Evolutionary Enlightenment, is well worth a visit. You will find interviews with all the most interesting people thinking about the evolutionary basis of human behaviour (and also C & U Frith)”.

Chris Frith, Emeritus professor of neuropsychology, University College London.

"I'd like to recommend Javier "Germanico" Moreno as en amazing person, whose intellect and passion resulted in creation of one of the most professional popular-science web services. The list of the outstanding researchers from different fields of science, who took part in his project is really impressive. I'm sure he will be able to engage himself in other activities with equal passion and professionalism".